Healthcare Provider Details

I. General information

NPI: 1619493061
Provider Name (Legal Business Name): AMANDA MARIE KOZLIK PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 08/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 STATE ST
SPRINGFIELD MA
01109-4109
US

IV. Provider business mailing address

77 RIVER RD
WARE MA
01082-9517
US

V. Phone/Fax

Practice location:
  • Phone: 413-731-6410
  • Fax:
Mailing address:
  • Phone: 413-658-8555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH237582
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: